肺癌淋巴结微转移诊断的对比研究

Comparative study for detecting micrometasteses of lymph nodes in patients with lung cancer

目的探索检测非小细胞肺癌淋巴结微转移的新途径。方法术中将25例非小细胞肺癌患者共195枚淋巴结平均分成两半，一半淋巴结用于常规病理和免疫组织化学染色；另一半淋巴结，按区域混合，用于逆转录聚合酶链反应（RT-PCR）。如果一枚淋巴结常规病理证实有显性转移，该患者同一区域的其他淋巴结不再接受免疫组织化学染色或RT-PCR检测。结果135枚常规病理阴性的淋巴结接受了免疫组织化学染色，31枚淋巴结显现肿瘤微转移。39组常规病理阴性的区域淋巴结混合组织中，11组RT-PCR检测呈阳性。免疫组织化学染色和RT-PCR检测肺癌淋巴结微转移，结果间存在一致性（U=7．682，P=0．0001）。结论免疫组织化学染色能提高非小细胞肺癌淋巴结微转移的检出率，并可对部分Ⅰ、Ⅱ期患者重新进行TNM分期。RT-PCR在检测肺癌淋巴结微转移方面，与免疫组织化学染色价值相当。RT-PCR可以简化淋巴结微转移的检测。

Objective To set up a new method to detect occult micrometasteses of lymph nodes in patients with no-small-cell lung cancer （NSCLC）. Methods We had detected 195 lymph node samples taken from 25 patients with NSCLC during the operations. Each lymph node sample was divided into two same parts in size. The one half part of lymph node should be examined by conventional histopathologic examination and immunohistochemical （ IHC ） staining. All the remaining lymph node samples of each patient should be mixed together for the reverse transciptase——polymerase chain reaction （RT-PCR） if they located in the same region. As long as the presence of metastatic tumor in one lymph node was found by H＆E staining, all other lymph node samples in the same region should not be detected by IHC staining or RT-PCR techniques. Results Frozen tissue sections of 135 lymph nodes that were staged as free of metastases by conventional histopathologic examination were screened by IHC staining. 31 lymph nodes showed single cell or cells clusters. Of 39 groups mixed regional lymph nodes which were diagnosed to be devoid of metastases by conventional histopathologic examination, 11 groups were found to have positive reactions to cyokeratin 19-mRNA by RT-PCR. There was a correlation between IHC staining and RT-PCR for detection of nodal micrometastases of NSCLC （ U = 7. 682, P = 0. 0001 ）. Conclusion IHC staining analysis can facilitate the detection of occult micrometastases in lymph nodes of NSCLC, and its assessment of nodal micrometastases can provide a refinement of TNM stage for partial patients with stage Ⅰ to Ⅱ. RT-PCR has the same value as IHC staining in detection of lymph nodal micrometastases. RT-PCR technique can reduce expense of the detecting micrometastases in lymph nodes.